Pilocarpine Treatment of Salivary Gland Hypofunction and Dry Mouth (Xerostomia)

Fox, Philip C.; Atkinson, Jane C.; Macynski, Alice A.; Wolff, Ändy; Kung, David S.; Valdez, Ingrid H.; Jackson, William F.; Delapenha, Robert; Shiroky, J. B.; Baum, Bruce J.

doi:10.1001/archinte.1991.00400060085014

Cited by 167 publications

(61 citation statements)

References 10 publications

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“…Flow rates slowly decreased, reaching baseline values within 3 h. When pilocarpine was administered flow rates were 10 times that with placebo, which produced no difference from baseline [17]. In a double-blind, placebo-controlled study in 39 patients with radiation-induced xerostomia, unstimulated major salivary gland output was significantly increased in 26 of 39 patients after initial exposure to pilocarpine 5 mg, and 27 of 39 patients showed symptom improvement after 1 month of treatment with pilocarpine 5 mg three times daily [18]. At 6 months after treatment patients were still experiencing relief of their symptoms [18].…”

Section: Sialogoguesmentioning

confidence: 92%

“…In a double-blind, placebo-controlled study in 39 patients with radiation-induced xerostomia, unstimulated major salivary gland output was significantly increased in 26 of 39 patients after initial exposure to pilocarpine 5 mg, and 27 of 39 patients showed symptom improvement after 1 month of treatment with pilocarpine 5 mg three times daily [18]. At 6 months after treatment patients were still experiencing relief of their symptoms [18]. A doubleblind, cross-over study in 12 subjects with xerostomia caused by irradiation was performed by Greenspan and Daniels [21,22].…”

Section: Sialogoguesmentioning

confidence: 97%

“…Pilocarpine 5-10 mg three times daily was effective in stimulating salivary secretion and improving symptoms of xerostomia, including difficulty in swallowing, chewing and speaking, in a significantly higher percentage of patients than placebo [17,18,21,22]. In a double-blind, placebo-controlled, cross-over study, 5 mg pilocarpine in patients with subjective xerostomia and documented salivary gland dysfunction increased salivary flow of the parotid gland within 30 min following administration, with a maximum flow at 45 min [17].…”

Section: Sialogoguesmentioning

confidence: 99%

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Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment

Guchelaar

Vermes

1997

Supportive Care in Cancer

152

105

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Xerostomia, or oral dryness, is one of the most common complaints experienced by patients who have had radiotherapy of the oral cavity and neck region. The hallmarks of radiation-induced damage are acinar atrophy and chronic inflammation of the salivary glands. The early response, resulting in atrophy of the secretory cells without inflammation might be due to radiation-induced apoptosis. In contrast, the late response with inflammation could be a result of radiation-induced necrosis. The subjective complaint of a dry mouth appears to be poorly correlated with objective findings of salivary gland dysfunction. Xerostomia, with secondary symptoms of increased dental caries, difficulty in chewing, swallowing and speaking, and an increased incidence of oral candidiasis, can have a significant effect on the quality of life. At present there is no causal treatment for radiation-induced xerostomia. Temporary symptomatic relief can be offered by moistening agents and saliva substitutes, and is the only option for patients without residual salivary function. In patients with residual salivary function, oral administration of pilocarpine 5-10 mg three times a day is effective in increasing salivary flow and improving the symptoms of xerostomia, and this therapy should be considered as the treatment of choice. Effectiveness of sialogogue treatment requires residual salivary function, which emphasizes the potential benefit from sparing normal tissue during irradiation. The hypothesis concerning the existence of early apoptotic and late necrotic effects of irradiation on the salivary glands theoretically offers a way of achieving this goal.

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Section: Sialogoguesmentioning

confidence: 92%

Section: Sialogoguesmentioning

confidence: 97%

Section: Sialogoguesmentioning

confidence: 99%

See 1 more Smart Citation

Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment

Guchelaar

Vermes

1997

Supportive Care in Cancer

152

105

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“…Pilocarpine has been shown to enhance salivary secretion by stimulating muscarinic receptors on the surfaces of the salivary gland cells, and thereby reduces the sensation of dry mouth in patients in whom some functional salivary gland tissue has been preserved [90]. Pilocarpine hydrochloride (HCl) is approved in several countries for the treatment of xerostomia induced by radiotherapy in the head and neck region [91].…”

Section: Muscarinic Agonist Stimulationmentioning

confidence: 99%

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact

Jensen

Pedersen

Vissink

et al. 2010

Support Care Cancer

228

180

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There is evidence that salivary gland hypofunction and xerostomia induced by cancer therapies can be prevented or symptoms be minimized to some degree, depending on the type of cancer treatment. Management guideline recommendations are provided for IMRT, amifostine, muscarinic agonist stimulation, oral mucosal lubricants, acupuncture, and submandibular gland transfer. Fields of sparse literature identified included effects of gustatory and masticatory stimulation, specific oral mucosal lubricant formulas, submandibular gland transfer, acupuncture, hyperbaric oxygen treatment, management strategies in pediatric cancer populations, and the economic consequences of salivary gland hypofunction and xerostomia.

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“…It was also found to increase salivary flow in patients with Sjogren's syndrome (Vivino et al, 1999;Fox et al, 1991). Therefore, pilocarpine (Salagen) tablets are commonly prescribed both for the treatment of dry mouth as a result of radiation therapy for cancers of the head and neck; and for dry mouth and dry eyes secondary to Sjogren's syndrome.…”

Section: Figure 1amentioning

confidence: 99%

An Interprofessional Study of the Effects of Topical Pilocarpine on Oral and Visual Function

Hua

Kawasaki

Pokala

et al. 2012

Health and Interprofessional Practice

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Pilocarpine Treatment of Salivary Gland Hypofunction and Dry Mouth (Xerostomia)

Cited by 167 publications

References 10 publications

Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment

Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment

A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact

An Interprofessional Study of the Effects of Topical Pilocarpine on Oral and Visual Function

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